Human T-Cell Lymphotropic Virus Type I—Associated Adult T-Cell Leukemia

Abstract

SELECTED CASE A 37-year-old Jamaican woman developed a generalized erythematous maculopapular rash. She had a peripheral white blood cell (WBC) count of 37×10 9 /L, 75% of which were malignant T cells with convoluted nuclei. The diagnosis of human T-cell lymphotropic virus type I (HTLV-I)—related adult T-cell leukemia/lymphoma (ATL) was supported by high titers of antibodies to HTLV-I in the peripheral blood. The patient was referred to the National Institutes of Health for treatment. Results of physical examination on admission were normal, with the exception of a generalized nonpuritic maculopapular skin rash. The patient manifested overt leukemia with a peripheral WBC count of 32.6 ×10 9 /L, 83% of which were malignant T cells. The phenotype of the malignant cells was CD3 + , CD4 + , CD8 - , CD7 - , and CD25 + . The serum concentration of soluble CD25 was elevated to 3645 units (normal geometric mean 235, with 95% confidence interval of 112 to 502